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  • Assessing Medical Students’ Clinical & Scientific Recalling, Reasoning & Decision Making Abilities


  • At the end of this workshop you will be able to:
    • determine which tests & techniques best help students develop clinical and scientific reasoning skills
      • and which simply assess & reinforce their ability to memorise factual information
    • compose selected-response items that measure clinical & scientific reasoning abilities

    • Highlight pertinent research
      • evaluate selected-response to other assessment formats
      • compare T/F and Best One of ‘N’ formats
    • Review basic do’s and don’ts in writing items
    • Clinical vignettes
      • useful aid in assessing clinical reasoning
      • recommended format
      • useful templates for clinical student assessments
      • helpful templates for integrating clinical and basic science student assessments
  • Overview (cont’d):

Practice in writing items that measure

  • Practice in writing items that measure
  • Practice in critiquing items
  • Understand Extended Matching format (Day 1)
  • Develop & use Extended Matching Items (Day 2)
  • Understand Pick n Best Choices from N Options format (Day 2)
  • Overview (cont’d):


  • Feel warmly welcomed & very comfortable
    • to challenge, question, suggest, seek clarification
      • at any point throughout the workshop

What’s the relevant research?

1. Key Research Finding:

  • What is best learned is not what’s taught
  • What is best learned is what’s tested

If one teaches clinical & scientific reasoning, but

  • If one teaches clinical & scientific reasoning, but
    • tests for only recall of scientific & clinical facts, then
    • students will learn primarily facts
      • and very few reasoning or problem solving skills

Thus, the key criterion for good exams

  • Create tests that assess what you want your students to learn

2. Research:Two components of a test …determine its validity:

  • Content
  • Format
  • Both influence if one obtains a valid measure
  • e.g., of either clinical & scientific reasoning or
  • an ability in memorising clinical & scientific facts

Related Research Findings:

  • Some test formats are regarded by students to tap certain skills better than other formats

Perceived purposes of test formats

  • Essays
  • Short answer
  • Bedside orals, Viva
  • OSCE
  • Reasoning, synthesis, organisation
  • Facts: Recall (not recognition)
  • Clinical skills (non standardised), in-& depth probing (in any direction)
  • Standardised clinical & practical skills

Thus, 2nd criterion for good exams

  • Use a test format that appears to the student to tap the skill that you want to be learned
    • in assessment jargon: ensure there is “face validity”
    • if students think test format requires reasoning skills, their study efforts become directed at these skills

Additional Research Findings:

  • Examination results improve as predictors of future clinical competence if
    • based on a representative sampling of pertinent clinical skills and scientific knowledge (validity)
    • based on a large sample of these attributes (precision)
      • sample size can be increased by using long tests, or by using more short tests (latter has some advantages)

Thus, 3rd criterion for good exams

  • Test large samples of the skills and knowledge that you want the students to learn
      • important for separating those who do & don’t meet the bar of minimally acceptable performance (e.g., pass/fail)

Thus, 4th criterion for good exams

  • Enable representative sampling

Review: The “Musts”

  • 1. Test for the ability that needs to be acquired
  • 2. Use a test format that appears to students to test what you asked/want them to learn
  • 3. Test a representative sample of the skills
  • 4. Test a lot of these skills


Each test format has some shortfalls

  • Essays
  • Short answer
  • Orals, Viva
  • OSCE
  • Poor sampling; poor reliability; long time needed to mark
  • Often only facts tested; reliability and time for marking improved (not best);
  • Poor sampling; poor reliability; not equivalent across students; time needed for administration is longer
  • Better sampling and reliability (not best); much preparation time in relation to sampling
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